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. 2011 Jun 1;29(16):2240-6.
doi: 10.1200/JCO.2010.31.3353. Epub 2011 May 2.

Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model

Kiran Naqvi  1 , Guillermo Garcia-Manero, Sagar Sardesai, Jeong Oh, Carlos E Vigil, Sherry Pierce, Xiudong Lei, Jianqin Shan, Hagop M Kantarjian, Maria E Suarez-Almazor
Affiliations

Association of comorbidities with overall survival in myelodysplastic syndrome: development of a prognostic model

Kiran Naqvi et al. J Clin Oncol. .

Abstract

Purpose: Patients with cancer often experience comorbidities that may affect their prognosis and outcome. The objective of this study was to determine the effect of comorbidities on the survival of patients with myelodysplastic syndrome (MDS).

Patients and methods: We conducted a retrospective cohort study of 600 consecutive patients with MDS who presented to MD Anderson Cancer Center from January 2002 to December 2004. The Adult Comorbidity Evaluation-27 (ACE-27) scale was used to assess comorbidities. Data on demographics, International Prognostic Scoring System (IPSS), treatment, and outcome (leukemic transformation and survival) were collected. Kaplan-Meier methods and Cox regression were used to assess survival. A prognostic model incorporating baseline comorbidities with age and IPSS was developed to predict survival.

Results: Overall median survival was 18.6 months. According to the ACE-27 categories, median survival was 31.8, 16.8, 15.2, and 9.7 months for those with none, mild, moderate, and severe comorbidities, respectively (P < .001). Adjusted hazard ratios were 1.3, 1.6, and 2.3 for mild, moderate, and severe comorbidities, respectively, compared with no comorbidities (P < .001). A final prognostic model including age, IPSS, and comorbidity score predicted median survival of 43.0, 23.0, and 9.0 months for lower-, intermediate-, and high-risk groups, respectively (P < .001).

Conclusion: Comorbidities have a significant impact on the survival of patients with MDS. Patients with severe comorbidity had a 50% decrease in survival, independent of age and IPSS risk group. A comprehensive assessment of the severity of comorbidities helps predict survival in patients with MDS.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Survival curves by Adult Comorbidity Evaluation-27 (ACE-27) comorbidity score. Each line represents survival according to ACE-27 score. Patients with no comorbidity (ACE-27 score, 0; solid blue line) have the longest survival, whereas those with severe comorbidity (ACE-27 score, 3; dotted blue line) have the shortest survival.
Fig 2.
Fig 2.
Survival curves by comorbidity score and (A, B, C, D) International Prognostic Scoring System (IPSS). (A) Low IPSS score; (B) intermediate-1 IPSS score; (C) intermediate-2 IPSS score; (D) high IPSS score. (E, F) Survival curves by comorbidity score and age. (E) Age 65 years or younger; (F) older than age 65 years.
Fig 3.
Fig 3.
Survival curves by proposed risk model for all patients. Risk groups are represented by three different lines, with those in the low-risk category having the longest survival (43 months) compared with those in the high-risk category (9 months).
See this image and copyright information in PMC

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